title: Echo-Doppler assessment of arterial stiffness in pediatric patients with Kawasaki disease.
abstract: BACKGROUND
  There is growing evidence to suggest increased arterial stiffness in patients with a history of Kawasaki disease (KD). Pulse-wave velocity (PWV) is the most validated measure of arterial stiffness. The aim of this study was to determine if aortic PWV is increased in children with KD.
  
  
  METHODS
  This was a retrospective cohort study. The study cohort was composed of 42 patients with KD (mean age, 9.7 ± 2.0 years) and 44 age-matched control subjects. The primary measure was aortic PWV. Secondary measures included characteristic impedance (Zc), input impedance (Zi), elastic pressure-strain modulus (Ep), and β stiffness index and the following measures of left ventricular size and function: end-diastolic and end-systolic dimensions, wall thickness in diastole and systole, mass, shortening and ejection fractions, mean velocity of circumferential fiber shortening, and stress at peak systole. The appropriate measures were indexed to body surface area. The aortic stiffness and impedance indexes were derived using an echocardiography-Doppler method.
  
  
  RESULTS
  Height, weight, body mass index, and body surface area were similar between the groups. PWV was higher in patients with KD compared with controls (495 vs 370 cm/sec, P = .0008). Zc, Ep, and β stiffness index were higher in patients with KD, but the difference was not statistically significant. Left ventricular dimensions were all within normal limits, with no differences between the groups. Patients with KD had lower stress at peak systole compared with controls (55 vs 64 g/cm(2), P = .01). There was a significant association between the length of time between the initial diagnosis and testing with PWV (r = 0.32, P = .04) and Zi (r = -0.38, P = .01) in patients with KD. There was no significant association between the arterial stiffness indexes (PWV, Zi, Zc, Ep, and β stiffness index) and length of fever, age at KD diagnosis, or heart rate. Logistic regression analysis revealed no association between coronary artery lesion classification and length of fever, day of illness at first treatment, age at KD diagnosis, or any of the arterial stiffness indexes. In the control group, there were significant associations between age and heart rate (r = -0.48, P = .001), Zi (r = -0.55, P < .0001), Zc (r = -0.66, P < .0001), and β stiffness index (r = -0.31, P = .04). There was an association between heart rate and Zc (r = 0.44, P = .003) but no association between heart rate and PWV, Zi, Ep, or β stiffness index.
  
  
  CONCLUSIONS
  Arterial stiffness was increased in children with KD. There was no association between acute-phase KD coronary involvement and PWV. This implies that patients with KD may be at increased cardiovascular risk in the future.
authors.affiliation: Children's Heart Center, British Columbia Children's Hospital and The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Abdullah
authors.initials: A
authors.lastname: AlHuzaimi
authors.forename: Yahya
authors.initials: Y
authors.lastname: Al Mashham
authors.forename: James E
authors.initials: JE
authors.lastname: Potts
authors.forename: Astrid M
authors.initials: AM
authors.lastname: De Souza
authors.forename: George G S
authors.initials: GG
authors.lastname: Sandor
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology; D002648:Child; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D063177:Pulse Wave Analysis; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D059289:Vascular Stiffness / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: AOcsa; AOd; AOflow; AOs; Aortic annular cross-sectional area; BPd; BPs; CAL; Characteristic impedance; Coronary artery lesion; Diastolic blood pressure; Diastolic posterior wall thickness; EF; Echocardiography Doppler; Ejection fraction; Elastic pressure-strain modulus; End-diastolic aortic dimension; End-systolic aortic dimension; Ep; Input impedance; KD; Kawasaki disease; LV; LVEDD; LVESD; LVMi; Left ventricular; Left ventricular end-diastolic dimension; Left ventricular end-systolic dimension; Left ventricular mass index; MVCFc; Mean velocity of circumferential fiber shortening; PP; PWV; PWd; PWs; Peak aortic flow; Pulse pressure; Pulse-wave velocity; SF; Shortening fraction; Stress at peak systole; Systolic blood pressure; Systolic posterior wall thickness; TT; Transit time; Vascular function; Zc; Zi; σps